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6 PERMIT APPLICATION <br />BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 1 FAX 425-257-8857 1(E) everetteps@everettwa.gov I www.everettwa.gov/permits <br />Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: 7410 Olympic Drive <br />PROPERTY TAX #: 00394000006600 <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />`CONTACT INFORMATION. <br />OWNER NAME: City of Everett TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: STREET 2930 Wetmore Ave <br />cnY Everett STATE WA zip 98201 <br />OWNER PHONE: <br />OWNER EMAIL: <br />CONTRACTOR NAME: To be determined at issuance <br />CONTRACTOR ADDRESS: STREET <br />CITY STATE ZIP <br />CONTRACTOR PHONE: <br />CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR OTHER (Please Specify) Applicant <br />CONTACT NAME: <br />Max Kvern <br />CONTACT PHONE: 206-434-7019 <br />CONTACT EMAIL: max.kvern taec.net <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: Water Tank Wireless Facility <br />Contract Price of Work: $ $20,000 <br />Proposed Use of Building: Water Tank Wireless Facility <br />Heat Source: ❑Gas ❑Electric ❑Other <br />Building Type: IMSFR-Detached ❑SFR-Attached ❑Du lex ❑Multi -Family-# of Units: ❑Commercial ❑Industrial <br />Type of Project: ❑New IaAddition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: <br />T-Mobile is proposing to modify an existing wireless facility located on a water tank. Please see building plans. <br />ASSOCIATED BUILDING PERMIT # if applicable): <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _ Addn _Alteration _Repair <br />Type of Project: _New Addn _Alteration _Repair <br />Fixtures <br />List of Fixtures <br />Fixtures <br />List of Fixtures <br />Fixtures <br />List of Fixtures <br />Fixtures <br />List of Fixtures <br />A/C —Air Handling Units <br />Heat Pump <br />Toilet <br />Backflow Preventer Inside Bldg) <br />Forced Air Systems <br />Unit Heater <br />Bathtub <br />Urinal <br />Gas Piping <br />Boiler <br />Lavatory Wash Basin <br />Drinking Fountain <br />Water Heater <br />Refrigeration <br />Shower <br />Floor Drain <br />Gas Fireplace <br />Wood Stove <br />Kitchen Sink & Disposal <br />Grease Trap <br />Gas Ran a <br />Ducting <br />Dishwasher <br />Roof Drains <br />Clothes Dryer Hookups <br />Other: <br />Clothes Washer <br />Medical Gas <br />Range Hood <br />Water Heater <br />Other: <br />Exhaust Fan <br />Sink Service/Bar/Mop/etc. <br />Other: <br />_ ____SPRINKLER <br />SUPPRESSION <br />SYSTEM_, <br />Chemical or Water <br />I <br />JNo. of Heads <br />ACKNOWLEDGEMENT. I have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must comply with <br />current federal, state, and local law. The granting of a permit only authorizes approved work and no deviations therefrom. Deviations must first be authorized in writing from the <br />Building Official before being authorized under any circumstance. 1 am the owner, or I am authorized by the owner of this property to perform the work for which application is made, <br />and I comply with the State Contractors Law 1&27 RCW and 296.200A WAC. <br />City of Everett Official Use Only <br />PFrRNIT#�o4 s o� <br />(Revised 912312016) <br />